Georgias Medicaid Waiver Programs Presentation to: MCAC Advisory - PowerPoint PPT Presentation

Georgia’s Medicaid Waiver Programs Presentation to: MCAC Advisory Committee Presented by: Brian Dowd, Program Director Waiver Programs Date: 11/16/16

Mission The Georgia Department of Community Health We will provide access to affordable, quality health care to Georgians through effective planning, purchasing and oversight. We are dedicated to A Healthy Georgia.

Georgia’s Medicaid Waiver Programs 1. GAPP Program (Georgia Pediatric Program) 2. NOW/COMP Waivers 3. ICWP Waiver 4. Elderly & Disabled Waiver (CCSP and SOURCE) *Demonstration Project

Review - Commonalities between all Waivers • Required to meet an institutional level of care • Medicaid or potentially Medicaid eligible • Services fall within the average cost of Medicaid reimbursed care provided in an institution • Member chooses community based rather than institution • Member may only participate in one waiver program • All waivers require Estate Recovery • All Waivers have Policy and Procedure Manuals listed on the Georgia Health Partnership website at www.mmis.georgia.gov

Medicaid Reimbursable Categories Ambulance Services Durable Medical Equipment Services Ambulatory Surgical Services Family Planning Services Certified Registered Nurse Anesthetists Health Check (Early and Periodic Screening, Diagnosis and Treatment) Childbirth Education Services Health Insurance Premium Purchase Program Children’s Intervention Services (HIPP) SOURCE Case Management Health Insurance Premiums (Medicare Part A and Diagnostic, Screening and Preventive Services Part B) (Health Departments) Home Health Services Dental Services Hospice Services Dialysis Services Inpatient and Outpatient Hospital Services Durable Medical Equipment Services Intermediate Care for the ID/DD Facility Services Family Planning Services Laboratory and Radiological Services Health Check (Early and Periodic Screening, Medicare Crossovers Diagnosis and Treatment)

Medicaid Reimbursable Categories Mental Health Clinic Services Psychological Services Non-Emergency Transportation Services Rural Health Clinic/Community Health Center Services Nurse Midwifery Services Swing Bed Services Nurse Practitioner Services Targeted Case Management Services Nursing Facility Services Therapeutic Residential Intervention Oral Surgery Vision Care Services Orthotic and Prosthetic Services Waiver Services Pharmacy Services Community Behavioral Health Services Physician Services Home Health Physician’s Assistant Services Podiatric Services Pre-Admission Screening/Annual Resident Review Pregnancy-Related Services

NOW/COMP Populations Served • The NOW and COMP waivers offer home and community- based services to people who have intellectual disability or developmental disabilities. • Requires diagnostic and functional evaluation – Occurs before Age 22 – Three or more functional impairments: • Self-care • Receptive and expressive language; • Learning; • Mobility; • Self-direction; and • Capacity for independent living.

NOW/COMP Services • Adult Occupational Therapy* • Individual Directed Goods and Services • Natural Support Training (NOW only) • Adult Physical Therapy* • Prevocational Services • Adult Speech and Language Therapy* • Respite (NOW only) • Behavioral Supports Consultation* • Specialized Medical Equipment* • Specialized Medical Supplies* • Behavioral Supports Service • Support Coordination • Community Access* • Intensive Support Coordination • Community Guide* • Supported Employment* • Community Living Support* • Vehicle Adaptation* • Community Residential Alternative • Transportation* • Environmental Accessibility Adaptation* *These services have Self-Direction/Co - • Financial Support Services Employer options

NOW/COMP Members Served as of 9/30/16 • NOW waiver: 4,488 • COMP waiver: 7,572 • Total ID/DD Waivers: 12,060

NOW/COMP Waiting List 9/30/16 • Short term planning list – 3,121 • Long term planning list – 5,577 • Total: 8,698

ICWP Waiver (Independent Care Waiver Program)

ICWP Populations Served • Serves individuals with physical disabilities or Traumatic Brain Injury who are age 21-64.

ICWP Eligibility • Physically disabled as determined by Social Security Administration • Between the age of 21 and 64 years of age • Severe physical impairment and/or traumatic brain injury • Meets the nursing home or hospital level of care criteria • Medicaid or potentially Medicaid eligible

ICWP Enrollment • Referral by self or other to GMCF (Georgia Medical Care Foundation): 800-982-0411 or 678-527-0319 or www.gmcf.org • GMCF sends out application and will send nurse for assessment once application received • Screening by RN through GMCF • Level of Care determination (DMA-6) • Assessment process • Case Management Services – Care Plan development – Broker of services

ICWP Services • Case Management • Counseling • Adult Day Services • Personal Supports • Behavioral Management • Specialized Medical • Emergency Response Equipment System • Environmental • Adult Day Services Modifications • Respite • Skilled Nursing • Alternate Living Service

ICWP Members Served • Independent Care Waiver Program (ICWP) – 1,301 active as of September 30, 2016 – 104 on waiting list as of September 30, 2016

Elderly and Disabled Waiver • Elderly and disabled population • Physical functional impairment • Unmet need for care

Elderly and Disabled Waiver Two Options in Georgia • CCSP (Community Care Services Program) • SOURCE

Elderly and Disabled Waiver • Waiver Services – Personal Support Services – Assisted Living Services – Home Delivered Meals – Adult Day Health – Home Delivered Services – Emergency Response System – Out of Home Respite Care

Elderly and Disabled Waiver • Level of Care – Intermediate Nursing Home • Plan of Care – Approved by physician • Cost of Services – Cannot exceed annual cost of care in nursing home

Elderly and Disabled Waiver • Eligibility – Intermediate Level of Care for Nursing Home Placement – Medicaid or Potentially Medicaid Eligible • CCSP- SSI or 300% of poverty • SOURCE- SSI or Public Law categories – Participation in no other waiver programs – Home environment is free of illegal behavior and threats of bodily harm

Waiver Enrollment-CCSP • Referrals made to Area Agency or Aging Gateway – 1-866-55-AGING to reach your local AAA • Clients are screened for CCSP and HCBS • Meets CCSP eligibility and funding available - client is referred to Care Coordination for initial RN assessment • Eligible and funding not available - client placed on WL • Client on WL are referred to Care Coordination based on highest DON-R score (highest need) • Clients 60+ may receive non-Medicaid services while on CCSP WL

Waiver Enrollment-SOURCE • Contact any SOURCE site that serves the county the member resides in. • SOURCE sites can be found on the MMIS website, www.mmis.georgia.gov – click on Provider Information to view the full list of Medicaid manuals, scroll alphabetically to the SOURCE manual, and go to Appendix EE. • SOURCE sites screen members for potential eligibility using DON-R instrument.

Waiver Enrollment-SOURCE • SOURCE sites submit DON-R instruments to DCH who maintains waiting list. • DCH will inform SOURCE sites of availability of slots as they become available. • RN will visit the home to complete assessment and submit level of care to GMCF. • GMCF notifies members of level of care denials and DCH of approvals for lock-in.

Waiver Participants • CCSP – 7,678 active as of September 30, 2016 – 1,162 individuals on the waiting list • SOURCE – 15,698 active as of September 30, 2016 – 306 individuals on the waiting list

Waiver Case Management • CCSP – Care Coordination • One agency contract in each Planning and Service Area • SOURCE – Enhanced Primary Care Case Management • Enrolled Medicaid Service Provider – Multiple options for case management – Case management options found in the HCBS program booklet and in the SOURCE policy manual

Questions? Brian Dowd bdowd@dch.ga.gov 404-651-6889